Provider Demographics
NPI:1750977963
Name:RHAMES, RANDY P
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:P
Last Name:RHAMES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2290 S VOLUSIA AVE STE H2
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-7600
Mailing Address - Country:US
Mailing Address - Phone:321-223-8644
Mailing Address - Fax:386-200-5862
Practice Address - Street 1:2290 S VOLUSIA AVE STE H2
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-7600
Practice Address - Country:US
Practice Address - Phone:321-223-8644
Practice Address - Fax:386-200-5862
Is Sole Proprietor?:No
Enumeration Date:2020-12-12
Last Update Date:2020-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299995122374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide